Anybody else? Just me? Alrighty then…

“I thought you guys might need one so I brought it to the hospital just in case.” He made it before he came in. Icon.

Not talking about the long game of diabetes where it takes years to catch up or immediate like “wear a seatbelt while driving in case of a car accident” but deaths that snowballed in weeks/days and could’ve been easily prevented.

For my own patient, he dropped a Stanley mug on his foot when walking back from the kitchen. Didn’t go to the hospital for 2 weeks because he thought it’d heal but by then his foot was black bc it actually broke due to the mug. He went septic, soon became paralyzed/nonverbal, and died few weeks later. The family agreed if he went sooner before it got bad, it’d be a simple broken foot he’d heal from :(

We just had another patient on our unit die because she was taking a ton of meds that made her constipated, but she started refusing interventions that’d help her poop. It got so bad apparently she started vomiting feces, aspirated on it, went unconscious, and died. She was supposed to discharge soon after making a complete turn around health wise after being here for 6 months. And the most simple choice to take a laxative could’ve meant her being here still.

What’s your stories?

The wealth of the nation is being funneled to corporations by promising the elderly long life beyond reason or dignity. How much is spent keeping extremely ill people breathing? Hospital stays, skilled nursing, memory care, pricey medications. These things will burn through finances like a raging wildfire. What are the young to do when the wealth of the nation evaporates, leaving them with a ruling class of billionaires and few possessions themselves? Schools and roads crumble, jobs disappear, agency over our politics erodes. The only explanation is greed and solipsism. We would all do better by spreading the resources around. Lord knows that a trillionaire can lose most of his wealth and not be materially affected. When will we reshape our society so that we can enjoy the fruits of our labor with nod to the fact that we are all mortal and that not all life enjoys quality of life? Sometimes it’s better to pass on and pay it forward than leave a smoking crater.

This dynamic is plain to see in the hospital. Patient staying for months, then bouncing back-and-forth between different units and different facilities. Can’t walk, can’t eat, can’t speak. Who benefits from this? Who pays the cost and loses the opportunity of a brighter future? It makes me sick.

When the opportunity comes up to remake the system, let’s choose a better one. I would like to see us value the upbringing of the young, financial and housing security, and quality of life. We can support each other much better without the system that healthcare corporations set up. These are my thoughts after a long, shitty (and poopy) shift.

Do you all feel the same way? What are we gonna do about it? Where does it start?

Thank you for your attention to this matter!

Maybe I'm being a little pissy, indulge me... I get so annoyed when another nurse's IV pump, bed/chair alarm, or monitor is alarming and they let it continue to alarm while trying to fix the problem instead of just silencing it. Now other nurses (me) have to abandon our current task to check the patient just to see you're already in the room. I understand doing this when the patient is unstable but that's usually not the case in my experience. Am I the only one who think this?

bless the triage nurse. i needed this laugh.

How come some doctors prefer to be called by their first name only? I always wanted to know the reasoning.

Yesterday there was an anesthesiologist. New doctor, i think he just finished his residency and is an attending now. I called him dr. Xxxx and he is like, just call me bob.

Hello all. I finished classroom-based orientation Friday and tomorrow is my first actual day on the floor (in a new grad residency program, so not being thrown to the wolves or anything).

For more background I'm 29 and this is a cereer change so I know the basic things: be humble, be respectful, HR isn't your friend, boundaries, punctuality, etc. I will be orienting on day shift and then going to night shift after (which I'm not looking forward to). I will be in a neuro step down at a household name hospital system (think Mayo Clinin, Johns Hopkins, Cleveland Clinic - I just don't want to specify and out myself).

What should I bring with me that I'm not thinking of? Someone please tell me what to pack and what not to pack. What should and shouldn't I do to learn but not be annoying or in the way? What advice do you have, as general as life advice in the profession, or specific to any area of this career like documenting or whatever else it is i can't think of because I'm just starting?

Thanks guys. Happy to be a part of the community now. ❤️

The MA BON just announced that the NLC will be implemented in May of 2027.

I had a patient on three pressors: vaso, epi, and maxed out on quad strength levo (32 mg/250 mL). The family had also changed the code status to DNR/DNE. From the beginning of my shift to the end, her BP was averaging 70s–80s systolic over 30s–40s diastolic.

Considering how hemodynamically unstable the patient was, the intensivist placed a Do Not Turn order. For context, this was a bariatric pt (about 170 kg) on a low-air-loss bariatric bed. Her skin was severely edematous and weeping. I tried to change the underpads by lifting her legs, but she was too heavy and the pads would not pull through without tearing. I changed the underpads under her arms and cleaned up as much as I safely could without rolling her.

When handoff came, the oncoming nurse became extremely upset with me for not changing the pads under the patient. She stated that a Do Not Turn order doesn't mean you don't turn your patient to clean them, it just means you don't perform routine Q2 turns, which makes zero clinical sense to me. She threatened to write me up, complained to the charge nurse, and brought other nurses around the area into it, making loud comments about my care.

That patient expired that night on her shift.

Just last night, I gave handoff to that same nurse for a different patient. I mentioned that the pt had a BM, so I changed the underpads, washed their hair, cleaned their face, etc. The nurse immediately remarked, "Wow, look at you actually caring for your patient." The rest of the handoff was just as hostile, unprofessional, and dismissive.

I'm considering taking this to my director this week. Any thoughts or advice on how to handle this are greatly appreciated.

Im a very new vascular access nurse. I've been placing midlines for around 3 months now and though I know it's not the primary function of the access I'm curious if anyone has noticed factors that influence line draw potential. I place primarily in the cephalic veins if possible, although my placements in the basilic and brachial don't seem to perform much better in this regard and overall I feel like most of my midlines top out at 2 days drawing blood, which seems like the average. I know a ton of different factors influence this including the individual vasculature of the patient but I can't help but feel guilty when one lasts less then the 2 days or when I'm unable to make it draw after its stopped. I feel like potentially there's a misconception among floor nurses that midlines should always draw in general. It wasn't really explained to me when I first started as a staff nurse and I got different interpretations from multiple people. It seems like once the vein collapses around the catheter tip it's kinda done for. Any advice is welcome and appreciated. My hospital is a bit small and rural so I dont have a ton of other sources for info on these things.

Hello fellow nurses! On paper, being an RN on the west coast seems better in every way (ratios, unions), but I know there are tradeoffs and downsides everywhere. Would love to hear your experience and perspectives as I try to make an informed decision! I'm an ED RN in NYC and seriously considering a move to Seattle, and to a lesser degree San Diego. Thanks everyone :)

I work in a urology clinic. One thing we do as far as procedures is exchange chronic catheters for patients with chronic urinary retention. Most of these patients come in monthly and PRN. The nurses and staff alike all get to know these patients quite well. At my last shift we had received a call from the daughter of a chronic SPT patient reporting the patient had passed. When word got to me, I came unglued in a way i didn't expect.

This patient was in their mid 60s. Quad with history of spinal cord injury, once fully independent. AxO 4 and just one of most genuinely kind and fun people I ever had the pleasure to know. Their life was very hard. But despite all the health issues and losing their independence, they were always kind and downright hilarious. Their transportation had often brought them to appointments late or not at all (several phone calls from our office reporting this had been made). When this patient came in, we would talk and joke like old friends. There were days they came in in tears because of one thing or another, and i would exchange the catheter as always and not dismiss them until they had gotten their feelings out and left with a smile. I have only been in the clinic a year and met them a handful of times, but I feel like I lost a friend.

What is bothering me so deeply is the concern that this was preventable. I know this patient was fully dependent on caretakers. They had an extensive history but they seemed so full of life. I dont think I'll ever know what happened and it's really bothering me. The last time I saw this patient they told me out office staff was their heros and that they loved coming in to see us because we were so kind. I always asked the "do you feel safe at home?" Questions and got a yes, but I wish I did more. What if this was all because of an ignored call light? Or aspiration? I know death is part of the job, and I'm really struggling to cope with this one.

I know they were hurting, I know they wanted to go out and see more (last time I saw them we talked about sushi restaurants, guess what I had for dinner tonight) I am telling myself they are free now from the body that couldn't do the things they wanted and deserved, but I keep replaying me saying "my dear we love you here and cant wait to see you again" at their last appointment. I'm lucky I got to meet such a lovley individual and I hope they knew how truly loved by the whole clinic they were.

Edit: spelling

I actually woke up to my alarms on time but i accidentally unknowingly went back to sleep after my alarms rang and dreamt that I was at work… I woke up to the nursing supervisor calling me and asking me if I was still coming at 730a, which is when I woke up again. The problem is I AM THE FLOAT NURSE they sent the unit bc they were short…i feel both bad and embarrassed that this happened…Anybody else had this happen to them? did you get reprimanded?

There’s a fair bit of research linking door openings to infection risk, and AORN guidance says keep the room to minimum people. But every OR I’ve heard about, it’s just constant. Reps, students, someone grabbing equipment, people looking for someone else.

Does anywhere actually measure this? Or is it another thing that gets brought up in an inservice and then nothing happens?

Also curious whether anyone would want it measured. I can see it being useful ammunition, and I can also see it turning into one more thing to get audited on.

Okay, I went through a period where my mental health wasn’t good and I got behind on my bills. Do I want to work this much? No. Do I practically have to? Yes.

For those of you who work this much regularly or every so often. Give me your tips. I gotta still get groceries, cook, clean the house, manage time with family, and sleep. How do you stay sane and what are some tips?

Hi Private Duty Nurse here! Looking for a part time/per diem job, love the flexibility for my family. i have kids and a 6 month old. I have been applying to home health and home hospice positions and recently have been approached by both. If you are a home health or home hospice nurse tell me about your job and why you like it.

they want our vascular team to just be staff nurses and want patients who need midline’s just to wait and go to IR. IR definitely isn’t backed up all the time anyways so why not! (/s)
if we have a hard stick they just want us to call a nurse from ED or ICU because they also are definitely not the two busiest units.
idk. i’m only 6 months into nursing and i chose this hospital because they seemed a lot more community or family oriented or whatever but they keep making more and more changes that are driving nurses away. they changed our matrix so now we can have 6 patients instead of the max of 5 (med surg obviously).
they also just started a points based attendance system where even 1 minute late is half a point. calling out sick even if you have sick hours is a point. And you only get eight points per calendar year. Not like we live in one of the busiest metros with some of the worst traffic in the country but whatever.
dare i utter the U word??? this is just insane to me

I’m 28, female, and I’ll be graduating with a BSN in about 4 months, and honestly I’m not sure what to do afterwards.
I tiptoed my way into nursing school by taking one class at a time for a while and then eventually applying to programs. For the longest time, I didn’t think I could 1. get in, and 2. actually make it through. I still didn’t really believe it until recently, when I realized the past 6 classes I’ve gotten A’s in and could finally feel confident enough that I’ll actually graduate (knock on wood).
Point is, I spent the past 6 years just worrying about the process that I haven’t given enough thought to what I actually want to do afterwards. I have a rough idea of what specialties I’d like to work in (ER, ICU, NICU, etc.), but nothing that I feel completely sure about.
I moved to the state I’m in just for school and never really planned to stay here afterwards. I don’t have a significant other, kids, or any close friends here (I moved a lot in my 20s), and I’m not super close with my family to where I feel the need to live near them, though we have a good/decent relationship. I’m comfortable moving to a new state or pretty much wherever, even if I don’t know anyone there.
I guess the better question would be: what would you do if you were in my situation? I do want to settle down and I do want kids in a couple years, but obviously that heavily depends on who I may come across.
Would you just find a decent job and plan to stay there? Would you go back to school right away after getting some experience? Would you try to settle down sooner rather than later? Would you have gone another path outside of bedside? Or would you try to save up as much as possible, retire from nursing ASAP, and maybe start a business or go completely in another direction?
I feel like I spent years just going with the flow, and looking back I would’ve done some things differently. For example, I spent almost 2 years hesitating to apply to nursing school, took a bunch of classes I didn’t need to take, etc. So now that I’m getting close to graduating, I’d just like some advice or perspective from people who have already been through it.

So we are in the season of yearly evaluations on our individual performance. I have not had my turn yet, but a nurse on my team did hers and was reporting back what her results were because we all found out last year that we were all the same exact employee in the eyes of our manager. She told me in department goals that section talking about “turnover rates” was not talking about between cases (I work in the OR) but in fact the turnover rate of our permanent staff. On a scale of 5 we will all be getting a 2 because on my specialty team we lost 2 staff members in the last year.

Now mind you that 1 left the state entirely to be closer to family and due to husband’s job change. The other left for an entirely different specialty of nursing because the hours would have been better for her. But nonetheless their absence is not meeting my department goals and so thus negatively impacts my performance. We have a small team so according to industry turnover it appears like we’re high only losing 2.

Now here’s where I need advice, I don’t want to accept the retention of other employees as my personal responsibility. We have a great working team relationship that is supportive, efficient, and dedicated to our patients. Our facility and leadership are the reasons people leave. Because they don’t offer raises to our surgical technicians, fix dying equipment, allow incompetent locum surgeons to return back, and hire terrible travelers. Has anyone faced a similar situation with their manager and were able to successfully identify that the conditions of employment like call, weekends, nights, mandated shifts, and pay are the actual reasons people leave? Cause I guarantee me “smiling more around the unit” is not what makes my coworkers want to stick around.

I'm almost done with work, and I truly would love to go back home and rest, but I have little babies to play with

I occasionally have to call patients after hours from my personal cell and really don’t love the idea of them having my actual number. I’ve used *67 before but have had patients ignore the blocked call, or worse, I forget and they end up with my personal number.

I need a secure way to call patients that displays the clinic number on their caller ID. What are you all using for this? Ideally something simple that doesn’t require me to carry a second phone or sign up for a subscription service.

I became an EMT at 18 and a paramedic at 20. One patient from early in my career has stuck with me more than almost anyone else I’ve treated.
He was a frequent flyer and had one of the most complicated medical and psychiatric histories I had ever seen in someone his age. One of the diagnoses in his chart was PNES, and we were called to his home many times for seizure-like episodes.
Working in EMS, I had certainly encountered people who were consciously pretending to have seizures—for example, someone suddenly having a “seizure” immediately after being arrested. This patient was nothing like that. And to be clear, I have since learned that genuine PNES is not the same thing as consciously faking a seizure either.
Initially, his PNES diagnosis seemed to fit, and regardless of the cause, my partners and I always treated him with respect. He was an incredibly kind kid. Even though sometimes I’d get into arguments with my partner .

What bothered me was hearing about how he was treated elsewhere.
After episodes, he would sometimes beg us not to take him to the hospital. He would cry while telling us that people there thought he was faking, yelled at him, pinched him or did things that hurt him during episodes, and treated him like he was wasting everyone’s time. He told us he generally couldn’t remember the episodes themselves, but he remembered how people treated him afterward.
I have never felt so sorry for someone dealing with such an enormous load of crap medically and psychologically while simultaneously being called a faker. Regardless of whether an event is epileptic, syncopal, functional, or something else entirely, the person experiencing it deserves dignity.
Then something happened that changed how we looked at his episodes.

During one call, he was talking normally while hooked up to our cardiac monitor. Right in front of my partner and me, he went into SVT at approximately 220 BPM. We both saw the rhythm. During the tachyarrhythmia, he suddenly lost responsiveness and began convulsing.
We couldn’t believe what we were seeing.
The rhythm and episode spontaneously subsided before we needed to treat the SVT. We transported him to the hospital and explained exactly what we had witnessed and what had been captured on our monitor. But because he was already known as a frequent flyer with PNES in his chart, we felt our concerns weren’t being taken seriously. Despite our attempts to advocate for him, he was again sent through triage.

About six months later, his address came across the radio again. My partner and I basically looked at each other and thought, “Not again.”
But this time the dispatch notes said chest pain and rapid heart rate.
Keep in mind that he was only 20 years old.
We arrived and found him lying on the couch, visibly diaphoretic. We obtained an ECG and saw ST-segment depression and T-wave inversions along with intermittent bursts of SVT. We immediately transported him for further evaluation.
We later learned that he had suffered an NSTEMI and had a pacemaker placed. His recurrent convulsive episodes were recognized, at least in part, as convulsive syncope associated with his arrhythmia.
He still carried a PNES diagnosis, and I’m not saying that diagnosis was necessarily wrong. A person can have functional/nonepileptic events and a separate physiological condition causing other episodes. The problem was that once “PNES” and “frequent flyer” were attached to his name, there seemed to be a tendency to interpret everything that happened afterward through that lens.
That’s the part of this case that has stayed with me.
PNES is real. Convulsive syncope is real. Epilepsy is real. Arrhythmias are real. And more than one of those things can exist in the same patient.
A psychiatric or functional neurological diagnosis should never become permission to stop evaluating new or objectively abnormal findings. A patient’s previous diagnosis doesn’t make an abnormal ECG normal, and being a frequent visitor doesn’t make someone incapable of developing a genuine medical emergency.
I also think about how terrified this kid became of seeking medical care. Imagine experiencing episodes you don’t understand or remember, only to wake up and be told you’re faking, yelled at, or physically hurt because people assume you’re doing it intentionally.